Tsymbal T. Pathogenetic markers of development of diabetic nephropathy in type 1 diabetic patients, their importence in the early diagnosis and treatment optimization

Object of the study: Diabetic nephropathy (DN) in patients with type 1 diabetes mellitus (DM). Aim of the study: to determine the role of some pathogenetic factors (transforming growth factor-?1 (TGF-?1), interleukin-6, tumornecrotic factor-? and homocysteine in blood serum) in forming tubulointerstitial changes in the kidneys of patients with type 1 diabetes. Pathogenetic justification of the use of combined nephroprotecting therapy with preparation of i-ACE group and glycosaminoglycans. Methods of the investigation and equipment: general clinical, biochemical, immunoenzymatic, and statistical methods; immunoenzymatic analyzer “Star Fax 3200”. Theoretical and practical results: it is shown that TGF-?1 level in blood serum of patients with type 1 diabetes begins to rise at the preclinical stage of DN (before MIA) and increases with the progression of the severity of this complication, that allows to consider this profibrotic cytokine as marker of preclinical diagnosis of DN. It was improved the management tactics of patients with DN, diagnosis and treatment of early stages of this complication. Novelty: data on the role of TGF-?1 in forming the tubulointerstitial kidney changes in DN that occur before the appearance of microalbuminuria were specified. An algorithm for diagnosing DN at preclinical stages was proposed. The scheme of nephroprotecting pathogenetic therapy in patients with type 1 diabetes and grade 3 diabetic nephropathy was supplemented; positive dynamics of fibrosis factor, MIA and GFR was demonstrated and the effectiveness of this therapy was proved. Degree of introduction: the results of study have been introduced to the work of Department of Diabetology of SI “V.P. Komisarenko Institute of Endocrinology and Metabolism, Natl. Acad. Med. Sci. of Ukraine”. Field of application: endocrinology.